Abstract

The debate on the ‘brain drain’, or the emigration of skilled workers, is not new but it has taken on greater urgency in the context of a globalizing economy and ageing societies. Today, the developed world is perceived as poaching the best and the brightest from the developing world, thus prejudicing those countries of their chance of development. This paper starts with two guarded caveats: first, that any brain drain is as much internal within any country as it is among countries and, second, that the skilled migration system should not be seen in isolation from other types of migration. The paper reviews the data available for the analysis of skilled migration and identifies the main global trends. It goes on to examine the globalization of education and of health as reflected in the movement of students and health personnel. Large numbers of people from developing countries are being trained overseas and, of those trained at home, many cannot be absorbed productively into their economies of origin. The paper examines the case for a two-tiered health training system, one for global markets and the other for local markets. Retention and return of the skilled are examined through the potential for outsourcing in both education and health care. However, the association between the presence or absence of health personnel and the health status of a population is seen as simplistic. The paper concludes with an examination of policy contradictions within the global system towards skilled migration and offers pointers towards a more integrated approach.